Basic Information
| Provider Information | |||||||||
| NPI: | 1841845559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAUCH | ||||||||
| FirstName: | ETHAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3404 W SYLVANIA AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436234467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194072663 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3404 W SYLVANIA AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436234467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194072663 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2019 | ||||||||
| LastUpdateDate: | 08/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | 03337920 | OH | N | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P1200X | 03337920 | OH | N | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 183500000X | 03337920 | OH | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.